Clinical and radiobiological consideration of cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin cancer disfiguring the face of a non-compliant patient who was refusing surgery and protracted radiation therapy: case report

Kil, Whoon Jong; Camphausen, Kevin; Cho, In Hye

doi:10.3857/roj.2019.00248

Cited by 9 publications

(16 citation statements)

References 14 publications

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“…Radiation was administered to 50 Gy in 4–5 fractions 17 . A study calculating the biological effectiveness of the quad shot regimen found 4–5 cycles is comparable to that from protracted definitive RT regimens 18 . Thus, in the palliative setting, quad shot is especially favorable as it meets all the major goals of therapy: attaining local tumor control, providing symptom palliation, an abbreviated treatment course, and minimal toxicity.…”

Section: Discussionmentioning

confidence: 99%

Proton radiotherapy for recurrent or metastatic sarcoma with palliative quad shot

et al. 2021

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Patients with previously treated, recurrent or metastatic sarcomas who have progressed on multiples lines of systemic therapy may have limited options for local control. We evaluated outcomes of palliative proton therapy with the quad shot regimen to unresectable disease for patients with recurrent and/or metastatic sarcoma. From 2014 to 2018, 28 patients with recurrent or metastatic sarcomas were treated to 40 total sites with palliative proton RT with quad shot (14.8 Gy/4 twice daily). Outcomes included toxicity, ability to receive further systemic therapy, and subjective palliative response. Univariate analysis was performed for local progression‐free survival (LPFS) and overall survival (OS). Of the 40 total sites, 25 (62.5%) received ≥3 cycles with median follow up of 12 months (IQR 4–19). The most common histologies were GIST (9; 22.5%) and leiomyosarcoma (7; 17.5%). A total of 27 (67.5%) sites were located in the abdomen or pelvis. Seventeen (42.5%) treatments involved concurrent systemic therapy and 13 (32.5%) patients received further systemic therapy following proton therapy. Overall subjective palliative response was 70%. Median LPFS was 11 months and 6‐month LPFS was 66.1%. On univariate analysis, receipt of four cycles of quad shot (HR 0.06, p = 0.02) and receipt of systemic therapy after completion of radiation therapy (HR 0.17, p = 0.02) were associated with improved LPFS. Three grade 3 acute toxicities were observed. The proton quad shot regimen serves as a feasible alternative for patients with previously treated, recurrent or metastatic sarcomas where overall treatment options may be limited.

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Section: Discussionmentioning

confidence: 99%

Proton radiotherapy for recurrent or metastatic sarcoma with palliative quad shot

et al. 2021

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“…For other organs at risk, the constraints were as low as reasonably achievable and followed suggestions from published recommendations. 8 For subsequent quad shots, patients underwent new CT-simulation scans to revise PTVs accounting for tumor response from previous quad shot.…”

Section: Methodsmentioning

confidence: 99%

“…Radiobiologic effectiveness of 3 or more cycles of quad shot is reportedly comparable to that of protracted definitive RT regimens, and hypofractionation may provide particular benefit to radio-resistant low alpha-beta ratio cancers. 7 , 8 , 9 , 10 Herein, we report responses from palliative RT using quad shot in elderly or frail patients with nonosseous metastatic/recurrent cancer in various anatomic sites with varying histology.…”

Section: Introductionmentioning

confidence: 99%

Rapid and Durable Symptom Palliation With Quad Shot Radiation Therapy to Nonosseous Metastatic/Recurrent Cancer in Elderly or Frail Patients in a Rural Community Clinic

Kil¹

2022

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…IMRT-QUAD was recommended for elderly patients comorbid with head and neck cancer (including parotid gland cancer) in recent studies, which was reasonable and safe to apply for symptom palliation with a reduced number of fractions. IMRT-QUAD can produce more rapid regression in tumors with an earlier alleviation of malignancy-related symptoms, and minimize acute and late toxicities in normal organs ( 30 , 31 ), impacting positively on patients’ quality of life (QoL) ( 32 ). Adjustment of PORT fractionation may need for patients in this high-risk group.…”

Section: Discussionmentioning

confidence: 99%

The Role of Postoperative Radiotherapy and Prognostic Model in Primary Squamous Cell Carcinoma of Parotid Gland

Qiu

Yong²,

Sun³

et al. 2021

Front. Oncol.

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BackgroundPrimary squamous cell carcinoma of parotid gland (parotid SCC) is a high malignant histologic subtype of parotid cancers with aggressive clinical presentation. However, the clinical features and survival benefit of postoperative radiotherapy (PORT) for primary parotid SCC are not well known.MethodsA retrospective population-based study was performed to identify the role of PORT in parotid SCC patients diagnosed between 1975 and 2016 from SEER database. A prognostic risk model was established based on patient clinical features, including age, tumor stage, and node involvement status. Patients were stratified into high, intermediate, and low risk according to this model. The survival benefit of radiotherapy was compared in the whole cohort and different risk groups.ResultsNine hundred thirty-one parotid SCC patients were extracted from SEER database, 634 (68.1%) in the RT group and 286 (30.7%) in the non-RT group. Overall, 503 (54.0%) deaths occurred, with a median follow-up of 84 months, the 5-year OS was 43.6% in the whole cohort, 47.7 vs 35.9% in patients with/without PORT (P = 0.005), and 58.9 vs. 38.8 vs. 27.1% in low-, intermediate-, and high-risk group (P < 0.001). Compared with surgery alone, PORT significantly improved the OS of patients with medium risk (47.5 vs. 20.6, P < 0.001), whereas not in the low risk (61 vs. 54%, P = 0.710) and high (25.6 vs. 28.7%, P = 0.524).ConclusionThis prognostic model can separate the patients with parotid squamous cell carcinoma into different risk. PORT significantly improved the OS of patients with intermediate risk, whereas high-risk group may need more intensive treatment strategies.

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Clinical and radiobiological consideration of cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin cancer disfiguring the face of a non-compliant patient who was refusing surgery and protracted radiation therapy: case report

Cited by 9 publications

References 14 publications

Proton radiotherapy for recurrent or metastatic sarcoma with palliative quad shot

Proton radiotherapy for recurrent or metastatic sarcoma with palliative quad shot

Rapid and Durable Symptom Palliation With Quad Shot Radiation Therapy to Nonosseous Metastatic/Recurrent Cancer in Elderly or Frail Patients in a Rural Community Clinic

The Role of Postoperative Radiotherapy and Prognostic Model in Primary Squamous Cell Carcinoma of Parotid Gland

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